Health care workers (HCW) in the Northern Territory are a vital link in the prevention of disease
transmission. There are inherent risks to both HCW and patients within the health care environment. Employment within ‘The Hospital’ places you at a higher risk of infection of some preventable diseases such as Tuberculosis and Varicella Zoster. Vaccination for preventable diseases reduces your risk of infection and are critical to the provision of a safe and healthy working environment. HCW can maximise their duty of care to patients by ensuring their vaccinations are kept up to date.
The central focus of this website is to provide new staff members further information on the NT Government Vaccination Schedule for HCW’s, Tuberculosis and Varicella Zoster virus.
Vaccinations requried by the NT Government
The National Immunisation Program (NIP) schedule(1) lists vaccinations for all people that are recommended by the federal government. Each state and territory receives funding from the federal government to purchase various combinations of vaccinations on the schedule, according to geographical and demographical influences (2). In addition, the 9th edition of the Immunisation Handbook recommends vaccinations specifically for occupational risk groups (3), including health workers (see table below).
Table 1: Recommended vaccinations for HCWs from the Immunisation Handbook 9th ed.
The Northern Territory government has adopted it's own immunisation schedules(4), however this does not include those recommended for HCW. Instead, the NT government leaves the immunisation of HCW and the costs associated with immunisation up to employers of such people (5). Each health care centre, hospital, other organisation or business that employs HCW may have their own immunisation requirements, and each may offer different funding for the immunisation of their staff. The Royal Darwin Hospital has it's own infection control guidelines (6), with a section dedicated to immunisation and testing requirements of its employee's. This is summarised in table below.
Table 2: Royal Darwin hospital recommendations of staff immunisation
It is important to note that the Northern Territory is associated with a higher risk of contracting Tuburculosis (see Incidence section below). Information on Tuberculosis and Varicella are listed below.
Tuberculosis (TB) is one of the deadliest infectious diseases in the world. It is caused by the mycobacterium M. tuberculosis. TB may be acquired through the inhalation of airborne particles from TB patients (ie: coughing, sneezing, talking, etc). These particles can remain suspended in the air for several hours. Any illness developed directly after infection is referred to as primary TB (mainly in infants and young children), which is severe, but usually not transmissible. If infected later in life, there is a better chance of the immune system controlling the infection. The risk of developing TB after infection mostly depends on how well the person’s immune system responds to the infection. The majority of people who get infected by TB develop the disease within 1-2 years after being infected. If a person has other diseases, it may favour the development of TB (ex: HIV, diabetes mellitus, chronic renal failure). Less than 10% of inhaled bacteria survive and multiply within the lungs. There are very few symptoms associated with the early stages of TB infection; however, two major host responses occur during the 2-4 weeks following infection: (1) A tissue-damaging response and (2) an immune response. Immune responses lead to the formation of lesions called tubercles, which limit the spreading of the bacteria – this leads to early cell death at the centre of the tubercle. Some lesions may heal, while others progress. Although some lesions heal, the bacteria can persist within immune cells for many years. Immune cell response is important at early stages because the infection can spread. During early infection stages, the bacteria are transported to lymph nodes where they can spread to the liver, spleen, bone, kidneys and lungs. There are two categories of pulmonary tuberculosis, primary and post-primary also known as secondary infection. Primary pulmonary tuberculosis is the first acquisition of the mycobacterium tuberculosis infecting the middle to the lower lung areas. Post primary tuberculosis is the reactivation of a latent TB infection. Infections present themselves on the apical and posterior segments of the upper lobes. Post primary infections severity can range from discernible chest radiographs to extensive cavitations and symptoms that will be debilitating to the patient. Symptoms of post primary TB include chills, night sweats, weight loss, anorexia, fevers and malaise. Development of coughs will present itself as a dry non-productive initially which will eventually become a productive cough with the expulsion of sputum. Extra pulmonary TB infections occur in other areas of the body systems these areas include the genitourinary tract, pleura, bone, joints and lymph nodes. Known studies show that extra pulmonary infections is more frequent in patients with HIV because of their inability to contain the mycobacterium tuberculosis due to the immunosuppressant effect caused by HIV. Detectable symptoms of extra pulmonary TB include fever, night sweats, weight loss and anorexia (7). Back to the TOP
Varicella zoster and herpes zoster
Varicella zoster (chickenpox) and herpes zoster (shingles) are both caused by the infection of varicella zoster virus (VZV) found in humans (8). They are two separate diseases, in which the primary infection causes chickenpox and reactivation of the virus causes shingles (8). These diseases are easily transmitted in the hospital to those at high risk (eg. immunocompromised, pregnant women and infants) and to HCWs who are exposed in the environment (9). Vaccination would provide health and safety benefits for both HCWs and patients.
Chickenpox is a common infection occurring in children and appears less than two weeks after the initial exposure of the virus, lasting up to two weeks. It is characterised by red, itchy vesicle skin rash found on the face, back, entire body, mouth, eye and genital area (10). Symptoms of coughing, runny nose can occur on the first two days of illness and other symptoms such as abdominal pain, fever, malaise and headache can be presented. The disease is highly contagious spreading through air and physical contact. It is regarded as a benign disease but complications like bacterial superinfections of the skin may occur (10). The virus stays within the body after resolution of the primary infection, and stays dormant in the dorsal root ganglia (11).
Factors that decrease the body's immunity such as aging and immunosuppression, can reactivate the virus leading to shingles (10). Reactivation can occur many years later after infection. The manifestation of shingles is characterised by unilateral distribution of vesicular rash, sensitivity and pain. It can appear on the side of the body, neck face and eyes. Prolonged symptoms may cause postherpetic neuralgia (12).
Video 1: The video below describes the pathophysiology herpes zoster (11)
Since the development of vaccines half way through the 20th century there is much evidence to suggest that the use of such medicines has preserved life and decreased the incidence of diseases like tuberculosis. Although tuberculosis still exists in all parts of the world the number of reported cases has decreased significantly since the introduction of a vaccine. However, there are a number of charcteristics or risk factors that increase the likelihood of contracting tuberculosis.
The following data has been taken from the Australian department of health and compares the incidences of tuberculosis within states and territories and to the rest of the world. It is important to note that the N.T. has the highest rate of tuberculosis in Australia.
Table 3: Notifications of new and relapsed cases of tuberculosis and notification rate per 100,000 population, Australia, 2007, by state or territory
Figure 1: Tuberculosis notification rate per 100,000 population, Australia, 1960 to 2007
Tuberculosis notification rate per 100,000 population, Australia,1960 to 2007
As figure 1 shows, there has been a significant decrease in the total number of reported cases since the 1960's or since the introduction of a vaccine to the population (15).
A risk factor that has been described by the Australian department of health regarding tuberculosis is indigenous background. Although there is no genetic factors which play a part in this, it is believed that socioeconomic factors and social standards are a key part in this risk factor.
The following table summarizes the incidences between indigenous and non indigenous cases reported in Australia in 2007.
Table 4: Notifications of tuberculosis and notification rate per 100,000 population in all Australian-born cases, Australia, 2007, by state or territory and indigenous status
Unlike tuberculosis varicella zoster is not a notifiable disease in every state or territory of Australia. Due to this there is not a lot of solid evidence into which areas are most affected by this disease. However, this particular disease can be narrowed down to age groups that are most likely to be affected.
Figure 2: Varicella notifications, South Australia, 2003 to 2005, by age group and sex (16)
Figure 50. Varicella notifications, South Australia, 2003 to 2005, by age group and sex
During the period 1 April 2007 to the 30 June 2008, there had been only two cases of Varicella (unspecified) reported in the Northern Territory, specifically the Alice springs reporting district. Back to the TOP
Concluding Statement
This website is a guide to understanding some of the risks involved in your new employment and the benefits of vaccinations. If you are unvaccinated your risk of infection increases for yourself and those around you. Vaccinations protect HCWs and patients from further health complications. It is especially important that HCWs have their tuberculosis and varicella immunisation status tested prior to commencing employment within health care facilities.
Northern Territory Government HCWs are entitled to some free vaccinations. If you require further information, please contact the Staff Vaccination team on 08 89412345.
Disease prevention starts with you
Table of Contents
Health care workers (HCW) in the Northern Territory are a vital link in the prevention of disease
transmission. There are inherent risks to both HCW and patients within the health care environment. Employment within ‘The Hospital’ places you at a higher risk of infection of some preventable diseases such as Tuberculosis and Varicella Zoster. Vaccination for preventable diseases reduces your risk of infection and are critical to the provision of a safe and healthy working environment. HCW can maximise their duty of care to patients by ensuring their vaccinations are kept up to date.
The central focus of this website is to provide new staff members further information on the NT Government Vaccination Schedule for HCW’s, Tuberculosis and Varicella Zoster virus.
Vaccinations requried by the NT Government
The National Immunisation Program (NIP) schedule(1) lists vaccinations for all people that are recommended by the federal government. Each state and territory receives funding from the federal government to purchase various combinations of vaccinations on the schedule, according to geographical and demographical influences (2). In addition, the 9th edition of the Immunisation Handbook recommends vaccinations specifically for occupational risk groups (3), including health workers (see table below).
Table 1: Recommended vaccinations for HCWs from the Immunisation Handbook 9th ed.
The Northern Territory government has adopted it's own immunisation schedules(4), however this does not include those recommended for HCW. Instead, the NT government leaves the immunisation of HCW and the costs associated with immunisation up to employers of such people (5). Each health care centre, hospital, other organisation or business that employs HCW may have their own immunisation requirements, and each may offer different funding for the immunisation of their staff. The Royal Darwin Hospital has it's own infection control guidelines (6), with a section dedicated to immunisation and testing requirements of its employee's. This is summarised in table below.
Back to the TOP
Table 2: Royal Darwin hospital recommendations of staff immunisation
It is important to note that the Northern Territory is associated with a higher risk of contracting Tuburculosis (see Incidence section below). Information on Tuberculosis and Varicella are listed below.
Back to the TOP
Tuberculosis
Tuberculosis (TB) is one of the deadliest infectious diseases in the world. It is caused by the mycobacterium M. tuberculosis. TB may be acquired through the inhalation of airborne particles from TB patients (ie: coughing, sneezing, talking, etc). These particles can remain suspended in the air for several hours. Any illness developed directly after infection is referred to as primary TB (mainly in infants and young children), which is severe, but usually not transmissible. If infected later in life, there is a better chance of the immune system controlling the infection. The risk of developing TB after infection mostly depends on how well the person’s immune system responds to the infection. The majority of people who get infected by TB develop the disease within 1-2 years after being infected. If a person has other diseases, it may favour the development of TB (ex: HIV, diabetes mellitus, chronic renal failure).
Less than 10% of inhaled bacteria survive and multiply within the lungs. There are very few symptoms associated with the early stages of TB infection; however, two major host responses occur during the 2-4 weeks following infection: (1) A tissue-damaging response and (2) an immune response. Immune responses lead to the formation of lesions called tubercles, which limit the spreading of the bacteria – this leads to early cell death at the centre of the tubercle. Some lesions may heal, while others progress. Although some lesions heal, the bacteria can persist within immune cells for many years. Immune cell response is important at early stages because the infection can spread. During early infection stages, the bacteria are transported to lymph nodes where they can spread to the liver, spleen, bone, kidneys and lungs.
There are two categories of pulmonary tuberculosis, primary and post-primary also known as secondary infection. Primary pulmonary tuberculosis is the first acquisition of the mycobacterium tuberculosis infecting the middle to the lower lung areas. Post primary tuberculosis is the reactivation of a latent TB infection. Infections present themselves on the apical and posterior segments of the upper lobes. Post primary infections severity can range from discernible chest radiographs to extensive cavitations and symptoms that will be debilitating to the patient. Symptoms of post primary TB include chills, night sweats, weight loss, anorexia, fevers and malaise. Development of coughs will present itself as a dry non-productive initially which will eventually become a productive cough with the expulsion of sputum. Extra pulmonary TB infections occur in other areas of the body systems these areas include the genitourinary tract, pleura, bone, joints and lymph nodes. Known studies show that extra pulmonary infections is more frequent in patients with HIV because of their inability to contain the mycobacterium tuberculosis due to the immunosuppressant effect caused by HIV. Detectable symptoms of extra pulmonary TB include fever, night sweats, weight loss and anorexia (7).
Back to the TOP
Varicella zoster and herpes zoster
Varicella zoster (chickenpox) and herpes zoster (shingles) are both caused by the infection of varicella zoster virus (VZV) found in humans (8). They are two separate diseases, in which the primary infection causes chickenpox and reactivation of the virus causes shingles (8).
These diseases are easily transmitted in the hospital to those at high risk (eg. immunocompromised, pregnant women and infants) and to HCWs who are exposed in the environment (9). Vaccination would provide health and safety benefits for both HCWs and patients.
Chickenpox is a common infection occurring in children and appears less than two weeks after the initial exposure of the virus, lasting up to two weeks. It is characterised by red, itchy vesicle skin rash found on the face, back, entire body, mouth, eye and genital area (10). Symptoms of coughing, runny nose can occur on the first two days of illness and other symptoms such as abdominal pain, fever, malaise and headache can be presented. The disease is highly contagious spreading through air and physical contact. It is regarded as a benign disease but complications like bacterial superinfections of the skin may occur (10). The virus stays within the body after resolution of the primary infection, and stays dormant in the dorsal root ganglia (11).
Factors that decrease the body's immunity such as aging and immunosuppression, can reactivate the virus leading to shingles (10). Reactivation can occur many years later after infection. The manifestation of shingles is characterised by unilateral distribution of vesicular rash, sensitivity and pain. It can appear on the side of the body, neck face and eyes. Prolonged symptoms may cause postherpetic neuralgia (12).
Video 1: The video below describes the pathophysiology herpes zoster (11)
Back to the TOP
Incidence rates of diseases
Incidence of tuberculosis in Australia
Since the development of vaccines half way through the 20th century there is much evidence to suggest that the use of such medicines has preserved life and decreased the incidence of diseases like tuberculosis. Although tuberculosis still exists in all parts of the world the number of reported cases has decreased significantly since the introduction of a vaccine. However, there are a number of charcteristics or risk factors that increase the likelihood of contracting tuberculosis.The following data has been taken from the Australian department of health and compares the incidences of tuberculosis within states and territories and to the rest of the world. It is important to note that the N.T. has the highest rate of tuberculosis in Australia.
Table 3: Notifications of new and relapsed cases of tuberculosis and notification rate per 100,000 population, Australia, 2007, by state or territory
Back to the TOP
Figure 1: Tuberculosis notification rate per 100,000 population, Australia, 1960 to 2007
A risk factor that has been described by the Australian department of health regarding tuberculosis is indigenous background. Although there is no genetic factors which play a part in this, it is believed that socioeconomic factors and social standards are a key part in this risk factor.
The following table summarizes the incidences between indigenous and non indigenous cases reported in Australia in 2007.
Back to the TOP
Table 4: Notifications of tuberculosis and notification rate per 100,000 population in all Australian-born cases, Australia, 2007, by state or territory and indigenous status
Back to the TOP
Incidence of Varicella Zoster in Australia
Unlike tuberculosis varicella zoster is not a notifiable disease in every state or territory of Australia. Due to this there is not a lot of solid evidence into which areas are most affected by this disease. However, this particular disease can be narrowed down to age groups that are most likely to be affected.Figure 2: Varicella notifications, South Australia, 2003 to 2005, by age group and sex (16)
During the period 1 April 2007 to the 30 June 2008, there had been only two cases of Varicella (unspecified) reported in the Northern Territory, specifically the Alice springs reporting district.
Back to the TOP
Concluding Statement
This website is a guide to understanding some of the risks involved in your new employment and the benefits of vaccinations. If you are unvaccinated your risk of infection increases for yourself and those around you. Vaccinations protect HCWs and patients from further health complications. It is especially important that HCWs have their tuberculosis and varicella immunisation status tested prior to commencing employment within health care facilities.
Northern Territory Government HCWs are entitled to some free vaccinations. If you require further information, please contact the Staff Vaccination team on 08 89412345.
Back to the TOP
References/Resources
1. Australian Government Department of Health and Ageing. National Immunisation Program Schedule. 2007 [cited 18/08/2010]. Available from: http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/E875BA5436C6DF9BCA2575BD001C80BF/$File/nip-schedule-card-july07.pdf. 2. Australian Government Department of Health and Ageing. National Immunisation Program Schedule. Australian Government Department of Health and Ageing; 2010 [cited 2010 18/08/2010]; Available from: http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/nips2.3. The Australian Immunisation Handbook. Vaccination of those at occupational risk. Canberra: Australian Government Department of Health and Aging; 2008.
4. Northern Territory Government. NT Immunisation Schedules. Northern Territory Government; 2008 [cited 2010 18/08/2010]; Available from: http://www.health.nt.gov.au/Centre_for_Disease_Control/Immunisation/NT_Immunisation_Schedules/index.aspx.5. Centre for Disease Control. Vaccines. Remote Health Atlas [serial online] 2007 [cited 18/08/2010]. Available from: http://remotehealthatlas.nt.gov.au/vaccines.pdf. 6. Royal Darwin Hospital Infection Control Department. Health care workers/Immunisation/TB screening. In: Royal Darwin Hospital Infection Control Manual. Darwin: Northern Territory Government Department of Helath and Families; 2004. p. 49-50. Australian Government Department of Health and Ageing. Communicable Diseases Intelligence Volume 33 No 3 - September 2009. [cited 16/08/2010]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3303f.htm
/main/publishing.nsf/Content/cda-cdi31suppl.htm~cda-cdi31suppl-3.htm~cda-cdi31suppl-3p.htm
7. Helms, RA; Quan, DJ; Herfindal, ET; Gourley, DR. Textbook of Therapeutics. Eighth Edition. Philadelphia: Lippincott Williams & Wilkins; 2006, pages 1940 - 1944 chapter 76. 8. Moon JE, Hospenthal DR. Herpes Zoster. Nov 23, 2009 [cited 2010 15/08/2010]; Available from: http://emedicine.medscape.com/article/218683-overview
9. Seale H, Leask J, Raina MacIntyre C. Do they accept compulsory vaccination?: Awareness, attitudes and behaviour of hospital health care workers following a new vaccination directive. Vaccine [serial online] 2009 [cited 2010 Aug 5];27(23):3022-5. Available from: http://www.sciencedirect.com/science/article/B6TD4-4W14GG9-3/2/dcb30a34aa5ddfe663b44969fff909fe.10. McGladdery, S (MD). Regional Medical Director First Med Centers. Hungary. [Accessed via http://www.youtube.com/watch?v=9wdU5zZlxew cited 15/8/2010] 11. Rothfield, G (MD). New York Dermatology - Board Certified Dermatologist. http://www.dermatologistsnyc.com/ [Accessed via http://www.youtube.com/watch?v=D3gQLKw3BbM, cited 15/8/10]12. de Melker H, Berbers G, Hahne S, Rumke H, van den Hof S, de Wit A, et al. The epidemiology of varicella and herpes zoster in The Netherlands: implications for varicella zoster virus vaccination. Vaccine. 2010 [cited 2010 12/08/2010]; Available from: file/view/varicella netherlands.pdf|http://pharmacycdu-pha312-grp4.wikispaces.com/file/view/varicella+netherlands.pdf
13. Chickenpox (Varicella) Photos Immunization Action Coalition; March 27, 2009 [15/8/2010]; Available from: http://www.vaccineinformation.org/varicel/photos.asp14.Shingles Herpes. Herpes Doctor. Redgold World Limited; 2005 [15/8/2010]; Available from: http://www.herpes-doctor.com/shingles-herpes.htm
15. Barry, C; Konstantinos, A. Tuberculosis notifications in Australia, 2007. CDI, Vol 33, No 3; Sep 2009http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3303f.htm
16. Australian Government Department of Health and Ageing. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Communicable Diseases Intelligence Volume 31. June 2007. [cited 16/08/2010]. Available from: http://www.health.gov.au/internet
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